Parents live in a retirement home. Who has authority to decide when it's time for Dad to be moved to the Alzheimer's section?

I too have been having these same questionings. My mother and Father are in an elderly independant apartment building connected with assisted living and full care facility that "step up" as needed. They have been there two years and other then having her toaster oven removed because the fire department came when the smoke alarm was set off when "Dad forgot he had toast in it" (of course he says Mom forgot..) So now we are worried about my mothers possible dementia. She has been parinoid, anxious, and thinks she has won some money from an organization she keeps sending money to. We ( my father and I) have been talking to the social worker there who keeps trying to schedule an evaluation which has been canceled 4 times. They want to put my mom on the "Assisted" program but she would stay in her apartment with dad. They would clean, give 10 hrs a week of personal care, manage meds, bath, provide a few meals a day... She is adament that she does not need this and her memory and health are fine. Dad protects and resists losing any of their independence. The cost increase is significant (over $6000 a month) and while you can select the service plan desired the cost is pretty much the same regardless. I know they keep an eye out for Mom, especially when my father, who is slightly younger and still travels to Florida for golf and sunnier weather, is not around. I am in a distant state and can only try to touch base daily with Mom and Dad at this time. I am so fortunate we got them into this place and out of the family home of forever, but now I worry about too much intervention. A frustrating situation!!

sabahmom,
A psychiatrist is the person to see and have evaluate both your dad & mom. My mom has dementia. Where she lives both can move into the memory care unit but the one who does not have dementia gets the code for the door, to come and leave the floor as they wish. It is not uncommon for violence to enter the picture with dementia. Do you really want to take a chance of your mom being hurt, possibly crippling or worse? No matter who you are and especially for long time spouses, making the decision to enter into memory care is very difficult. Denial is also a huge issue in these types of situations. Until you get to the appropriate doctor for an accurate assessment and treatment program, I'm sorry to say, I believe you are playing "russian roulette" with your mom's well being.

Milesaway,
Get them both to the appropriate independent (not affiliated with the facility) doctor for evaluation. It is not unusual for the afflicted to fight "tooth and nail" in defense of their independence. I used to think that paranoia was just the beginning symptoms of dementia. I really think that the afflicted person, knows that they are "losing it" and is fighting what they fear and know to be their future. For years before we acknowledged/accepted my mom's dementia, she accused us of what we thought were horrible allegations of taking her money, home and putting her away. The fact is that she was totally accurate in fortelling her future. After my dad died, I tried to have her come live with me. Her struggle for independence created issues that I couldn't handle, so we found a beautiful assisted living facility for her to live in. We "took" all of her assets and "put her away". We manage her finances in order to provide her the quality and style of life that she was accustom to, prior to my dad's death. She does complain about not having the freedom to walk out the door when she wants, but she also thinks she is living in a beautiful place where people wait on her hand and foot. When I go to take her out, she is very excited to go, but in a very short time of being away, she starts to talk about getting back. She falsely believes my sister was behind her losing her independence although I am the one who fought with her bitterly, moving her in. She is not rational and it is not her fault.

When we are caring for our parents, wherever they are, we have to remember that it is all about them and their safety and not about us and our emotions. If your Mom is not safe, for whatever reasons, then you have to make her safe. The same goes for your Dad. Each of them have their own issues and while realistically and emotionally you may want them together for the rest of their lives, due to safety concerns, this may not be the safest plan. It would be great if they could be in the same facility, but if they can't, then that is what is safe for them.

I am not so eager to ask MDs, especially not psychiatrists, for too much weight is given, in my opinion, by most parties involved, to psychiatrists or external experts, and any MD diagnosis is only as good as the details of information given to them. Standardized tests are not 100% accurate and there are other ways to observe to see if your parents are in a risky situation or not.. There is a qualitative difference between grabbing someone's arm to stop an action, and intending harm -some of that depends on whether the person adds hurt when grabbing it, or whether it is a restraining action only, how long, how brief.

It may be, that with your mom's frail size, Sabahmom, some coaching is needed to help your mother to manage her distance from her husband so that no accidents occur. And/or coaching to him, that if he is upset, he can practice saying so, without so much blaming her, and not touch her, for accidents can happen. The caregiver feedback is important as an alert to, but try to ask some less volatile questions than, is this person violent. I've found the question itself can led to suspicion and mistrust which alienates - I'd try find an observant, gentle but alert person nearby, even another caregiver, or someone outside the medical system, to visit them a few times - share your concerns and ask that person to observe whether they act comfortably around each other or not. That would add an extra input, other than just your mother's assertions - even though her assertions are vitally important in this - but if she is anxious around him, it should show a bit in other times. Sometimes professionals seem to get over-eager to avoid any suspicion of risk by intervening more strongly than is needed. Yes, the opposite can also happen, but if there is general trust and familiarity between the two, and respect, and care - and they want to continue living together, I'd try to add some outside supportive presence and checks, and only take next steps further if you see more risks.

If you have Power of Attorney over Dad's health/financial, YOU can make the decision. The POA gives you the 'power' so to speak. A neurologist is the best medical professional to assess your father. Once you have that result, the course of action will become apparent....not easier.....just clearer.
I went through this w/ my father. He did not like my decision, but it was the best for him and our family. In the 'board & care' facility I chose, he is clean, well-fed, and safe.
Aging is not for the faint-hearted, that's for sure, whether it's you or a loved one.
Best of luck...

Did you choose the facility because of the continuum of care? What made you choose that facility? You need to remember the reasons and trust the initial decisions that placed them there. Now is an emotional time with your father's disease progressing and your mother's desire to continue to care for him. The staff in these facilities are trained and know the warning signs. You should trust their assessment, they are only trying to keep them both safe.

What is a real shame is, busy body 's in the apartment that are just looking for something to tattle on. Most of the residents there are more than likely having similar problems but haven't been caught! I just went thru the same thing and now my parent has to leave independent to assisted. A much higher rate. I want so bad to tell all the busy body's to make sure of your facts before reporting someone, it could be you someday that is accused of not being able to care for yourself. I know some out there are really looking out for the good but the consequences of a bad call is terrible not just for the senior but for their family

I read your question this AM and decided to think about answering too quickly, but what I think this evening is what I thought this morning. The folks who are on the ground, in the situation with your mom and dad may actually have a more accurate, fact not emotion based observation of what is happening right now. You mention that your dad had "anger isssues". Was/is your mom an abused spouse? Most abused spouses, both male and female, protect the abuser from exposure for a variety of reasons. You obviously need input from an independent evaluator of some sort; yes, sometimes MDs don't get the whole picture, don't think this is just "busybodies" because it sounds like this has happened before. Get an outside assessment and try not to blow it off just because it doesn't fit with what you think is the picture. Your mom may need someone else to stand up and be the take-charge person on whom she can lay the blame for your dad's transfer, because to take charge herself would open her up to the possibility of more abuse.

Thank you for all your helpful answers. I am still of the opinion that the facility's intervention in removing my father that very night was over-the-top intervention. Castle, your comment was:
"Sometimes professionals seem to get over-eager to avoid any suspicion of risk by intervening more strongly than is needed. Yes, the opposite can also happen, but if there is general trust and familiarity between the two, and respect, and care - and they want to continue living together, I'd try to add some outside supportive presence and checks, and only take next steps further if you see more risks."

That is exactly it. And that is pretty much what we were deciding to do. But if nothing else, this incident did highlight to my mother that things really were changing and that we needed to get more help for them. We were in the process of continuing that conversation in the hopes of arriving at a mutually agreed-upon arrangement when something unrelated to my father's dementia happened just a few days later. He passed out and crumpled on top of her. This set off a chain of events that has ended up with his being moved to the Alzheimer section of their retirement home after he was released from the hospital just the other day.

So many of your comments have been helpful. At least it is "nobody's fault" that Dad got moved (least of all my Mom's for deciding this). It was clear to us all that they could not stay together given their current living arrangements. But we have the sudden trauma to deal with now of the way this all happened for Dad while simultaneously dealing with Mom's injuries and need for extra care. CandyKane57, as you said, aging is not for the faint of heart, for your or your loved one. As much as we'd all like to think that we can do it "right" and prevent anything bad from happening, life takes twists and turns that we don't expect. We certainly did not expect this.

Thank you for your helpful comments. Good to know others have walked this. Wanted to let you know that the initial "problem" has been "solved". No doubt we will be doing some serious regrouping in the days to come and I will probably be back here again ...

Hi - i am relating to the authority of the Care home ( Independent to assisted living) to "help" or "push" the progression of one parent ( they are both living in same unit) into the assisted level of care. I trust that they are loking out for the welfare of the clients (my partents) but wonder how well they are connected to the relationship and situation as it develops. They are "there" and I am states away. My mom is (in my opinion but lacking a full evaluation by Gerientologist) starting to have short term memory lapses but more importantly having delusions of winning millions in sweepstakes and anxiety and fears of people messing with her "stuff" and chasing her. The "high tech" people will come after her if she throws out the sweepstakes junk mail, etc. She is alone currently as she returned from Florida alone after getting anxious that she needed to see "Her Mail" so returned home. Father stayed in FL for a few more weeks as they had made plans with extended family to be there visiting. I feel I do not know if this is fear of losing independence or early dementia... I received a call today from the Home case worker saying that we need to do something about my mother.. She had seen her that morning and she was nervous, talking about hitting someone with her car ( later confirmed as a fender bump in a parking lot) and hiding her medication because the FBI was watching her. Hello..- Nervous caretaker, eh? SO here is the scenario... Mom and dad signed up to be in this senior living apartment a few years ago, that would progress to Assisted and then hospice/ full nursing home care, yet now they seem to not want this loss of independence taken from them, and are back treading to avoid the loss of independence ( and extra cost) of going into the assisted level of care. We have their home of 40 yrs on the market but it has not sold. The house is old and huge and too much for them to handle even with lots of help. If they are into this apartment ( bought in)- then they really do not have a choice to change the current track of care, right? I am not a POA or anything, Dad is totally with it, Mom thinks she is but that is questionable and is fighting any control of her via assisted living.... HELP!!! I have no power other then to encourage Pushing for additional care support (ie Assisted) or pushing for greater independence as long as possible. How have others handled this? A daughter too far away to know first hand..

Thoughts to milesaway - I've worked in eldercare about 15 years, and also had responsibility for my youngest brother with brain injury, through his adult life. Somewhere in the middle of the 35 years I was helping him,,, !) - I learned tricks that would have made it easier if I had learned earlier. Namely, that when you propose any change at all, to someone with memory issues or who is worried at some level about being able to handle things day to day - they will usually say "no" to the change. And conversely, my current patient who is 106, sometimes speaks about her plan to move to another place - you must also have found that you can't quite trust the accuracy of their plans or fears, and that doesn't mean they are losing their mind, maybe just their memory some. For you'd find even if you decided to agree that Mom should return to her former home - that on the actual day of the move, she would be stalling, inventing excuses - or, if she ever got there, she would find nothing the same. When folks lose some of their senses, they actually feel mostly comfortable within current routines, for those are familiar, and do not drain their energy the way changes would. I know it's very difficult from far away - my brother is now in a nursing home, 5 hours from me - and I know that I cannot trust his descriptions of how things are, because they change, soon after a phonecall. I have a great book called, "My Mother, Your Mother" : Embracing "slow medicine", the compassionate approach to caring for your loved ones." I love the book, if you can, check it out on Amazon. It reaffirms the need for elders to just have time to vent, describe some events in their day, without someone trying too quickly to make decisions about it. Signals will repeat themselves, and only real actions should be considered worrisome - and words don't have to be taken at face value - or even called "delusions". If she thinks she won the sweepstakes, one can just say, "Geez - I always wanted to do that', chuckle, and change the subject. When my 106 year old complained, I'd agree that it's often hard to sort things out, and just be quiet, and soon she would change the subject. Seems to me that if your parents are together, in an assisted living, that's a great deal, at an elder stage of life. You can tell the facility, you'd like to wait a while before making any changes, and see how it goes after that. I find so many professionals rush - check out that book! You might also wonder if your mom does any activities in the place - and if not, ask if there's a social worker or aide or someone who might encourage her (one good way to encourage many women elders, is to ask them to help YOU - to joing one activity in the center. Bridge game, hair done - taking part in any activity can help her focus on what she can do, instead of what she can't. Just thoughts here, but I do like the idea of taking one's time and seeking positive where one is, not always debating changes (I do that myself, better when I stop!)